Eritema nodoso hansênico com apresentação vesiculosa simulando infecção herpética: um relato de caso / Erythema nodosum leprosum with vesicular presentation simulating herpetic infection: a case report

Contexto: As reações hansênicas são episódios inflamatórios agudos imunomediados que podem ocorrer em indivíduos com hanseníase. Lesões atípicas de eritema nodoso hansênico (ENH) são raras e podem se apresentar como pústulas, bolhas, necrose, úlceras e, eventualmente, podem simular outras doenças como a síndrome de Sweet e eritema multiforme. Descrição do caso: Paciente do sexo masculino, 24 anos de idade, com diagnóstico prévio de hanseníase virchowiana e realização de tratamento adequado, com término da poliquimioterapia quatro anos antes de comparecer ao nosso serviço quando foi avaliado, apresentando pequenas vesículas translúcidas agrupadas sobre uma base eritematosa e áreas com crostas necróticas, simulando lesões herpéticas, na porção superior das costas, parte inferior do pescoço e haste do pênis. O exame histopatológico da biópsia cutânea foi sugestivo de reação tipo 2 e o tratamento com talidomida foi satisfatório. Discussão: As reações na hanseníase representam episódios de hipersensibilidade aguda a antígenos de Mycobacterium leprae e podem se desenvolver antes, durante ou após o término do tratamento. Acredita-se que o ENH, ou reações do tipo 2, ocorram devido à deposição de imunocomplexos em múltiplos órgãos em pacientes que apresentam a forma multibacilar. Conclusões: As reações hansênicas são desafios no manejo da hanseníase, especialmente pelo fato de a maioria das sequelas permanentes ser secundária a esses episódios inflamatórios agudos. O conhecimento das possíveis apresentações atípicas das reações hansênicas é fundamental para o diagnóstico precoce e o tratamento adequado, a fim de prevenir morbidade grave relacionada à hanseníase.

Response of fibroblastic rheumatism to infliximab.

Onset is usually sudden with symmetrical articular involvement of both small and large joints, occurrence of solid skin nodules, and rapid progression. Treatment is generally unrewarding. Here we report a severe and disabling case of FR responding favorably to infliximab therapy. After 32 weeks of continuous treatment, skin lesions dramatically improved and arthropathy partially regressed.

Actinic cheilitis: histologic study of the entire vermilion and comparison with previous biopsy.

BACKGROUND: Actinic cheilitis (AC), is the very superficial, incipient form of actinically induced squamous cell carcinoma of the lower lip. Few studies of actinic cheilitis analyzed the entire lip vermilion searching for microscopic areas of progressing carcinoma. METHODS: Twenty patients with biopsy proved actinic cheilitis presenting with diffuse clinical changes were submitted to vermilionectomy of lower lip. Surgical specimens were sectioned every 3 mm, studied histopathologically and findings were compared with the biopsy. Histological findings were classified as 'AC', carcinoma in situ (CIS), superficially invasive squamous cell carcinoma (SISCC), and invasive squamous cell carcinoma (ISCC). RESULTS: Comparison between biopsies and most severe changes on vermilionectomies revealed coincidental changes in 10 cases (50%), more severe changes on biopsy occurred in two cases (10%) and in eight cases (40%) the changes on vermilionectomy were more severe. SISCC was diagnosed in nine cases (45%): of these, two had been detected on biopsy, six had shown a milder aspect on biopsy, and in one biopsy had shown ISCC. Foci of discontinuous areas of SISCC were detected in four cases (20%). CONCLUSIONS: These findings suggest that cases of AC presenting with poorly demarcated lesions may bear severe histopathological changes irregularly distributed along the vermilion.

Lupus erythematosus: clinical and histopathological study of oral manifestations and immunohistochemical profile of epithelial maturation.

BACKGROUND: Lupus erythematosus (LE) is an autoimmune disease of unknown cause. Prevalence of oral involvement in patients with LE is uncertain but may vary from 9 to 45% in patients with systemic disease and from 3 to 20% in patients with chronic cutaneous involvement. METHODS: Incidence of oral lesions of LE and their clinical aspects were investigated. Their histopathologic features were analyzed, and the status of epithelial maturation was assessed through the expression patterns of cytokeratins. RESULTS: Twenty-six patients (from 188 examined) presented oral lesions of LE. Most of them were females (19) with systemic disease (11). Clinical aspects of these lesions varied, and lips and buccal mucosa were most affected. Histologically, lesions revealed lichenoid mucositis with perivascular infiltrate and thickening of basement. Cytokeratins profile showed hyperproliferative epithelium, with expression of CK5/6, and CK14 on all epithelial layers, CK16 on all suprabasal layers and CK10 on prickle cell layers only. CONCLUSIONS: Oral lesions of LE show a variety of aspects, and their microscopic features are of a lichenoid mucositis with deep inflammatory infiltrate. Cytokeratins expression patterns are of hyperproliferative epithelium, and this phenomenon must be analyzed in relation to the inflammatory cytokines for a better understanding of the mechanisms of the disease.

Childhood oral mucous membrane pemphigoid presenting as desquamative gingivitis in a 4-year-old girl.

Mucous membrane pemphigoid is a chronic inflammatory, bullous subepithelial auto-immune disease, with predominant involvement of the mucosal surfaces. Oral mucous membrane pemphigoid occurring in childhood is extremely rare. We describe a new case of this entity occurring in a 4-year-old girl who presented with desquamative gingivitis. Diagnosis was based on clinical presentation, histopathology, immunofluorescence and immunoblotting examinations. Treatment and 2-year follow-up are described.

Sarna costrosa en lactante cushingoide tratado con ivermectina oral / Crusted scabies in cushingoid child treated with oral ivermectin

La sarna costrosa o noruega constituye una forma grave, altamente contagiosa, de infestación por Sarcoptes scabiei, que se encuentra frecuentemente presente en individuos inmunosuprimidos. Diversas alternativas terapéuticas, tópicas y sistémicas, han sido utilizadas para combatir la enfermedad y evitar epidemias. La ivermectina es un acaricida oral utilizado en los últimos años para diversas parasitosis y ectoparasitosis. Presentamos el caso de un lactante masculino de 13 meses de edad, en tratamiento con corticoesteroides orales en altas dosis, que comienza a presentar dos meses atrás lesiones costrosas y escamosas con predominio en tronco, miembros, manos y orejas. Se hizo diagnóstico clínico, corroborando con examen directo, de sarna costrosa. Iniciamos ivermectina oral 200 mcg por kilo de peso y obtuvimos curación después de dos semanas de iniciado el tratamiento

Sarna costrosa en lactante cushingoide tratado con ivermectina oral / Crusted scabies in cushingoid child treated with oral ivermectin

La sarna costrosa o noruega constituye una forma grave, altamente contagiosa, de infestación por Sarcoptes scabiei, que se encuentra frecuentemente presente en individuos inmunosuprimidos. Diversas alternativas terapéuticas, tópicas y sistémicas, han sido utilizadas para combatir la enfermedad y evitar epidemias. La ivermectina es un acaricida oral utilizado en los últimos años para diversas parasitosis y ectoparasitosis. Presentamos el caso de un lactante masculino de 13 meses de edad, en tratamiento con corticoesteroides orales en altas dosis, que comienza a presentar dos meses atrás lesiones costrosas y escamosas con predominio en tronco, miembros, manos y orejas. Se hizo diagnóstico clínico, corroborando con examen directo, de sarna costrosa. Iniciamos ivermectina oral 200 mcg por kilo de peso y obtuvimos curación después de dos semanas de iniciado el tratamiento (AU)